/ 10 June 2011

HIV response: Simpler is better

Hiv Response: Simpler Is Better

About 1.4-million South Africans with HIV/Aids are receiving antiretroviral treatment — a figure closer to the target set by the present national strategic plan than expected, according to Mark Heywood, deputy chair of the South African National Aids Council (Sanac).

Addressing delegates at the 5th South African Aids Conference in Durban this week, Heywood said the 2007-2011 national strategic plan had failed dismally with regard to monitoring and evaluation, however, and that the next plan must embody a simpler approach.

One of the goals of the present plan is the extension of treatment and care to 80% of all HIV-positive people and their families by year end. The latest statistics indicate that 80% of those with a CD4 count (measure of immunity) of 200 and below are now receiving treatment. The aim is to increase the total number of beneficiaries to 2.3-million by 2012 and expand treatment to those with CD4 counts of 350 and below, as recommended by the World Health Organisation.

According to the government, almost 12-million South Africans have had HIV tests since April last year. But the plan’s record is less impressive in terms of its other major objective — the halving of new HIV infections. Heywood said the next national strategic plan — which will run from 2012 to 2016 — had to ensure there were structures in place to measure HIV incidence, with a bigger focus on prevention.

Interest groups had to fight hard for the ambitious treatment targets to be included in the present plan in the face of stiff opposition from former health minister Manto Tshabalala-Msimang and her director general, Thami Mseleku.

Several sessions at the Aids conference attempted to garner input on what should be included in the next plan, which will guide the country’s response to HIV/Aids over the next four years. Heywood said an “unstrategic wish list” had to be avoided. “The next national strategic plan must be more strategic, simpler and easier for people to mobilise around. Our first departure — also needs to be the inclusion of tuberculosis,” he said.

The first step would be a national strategic framework within which provinces, government departments and civil society organisations could develop operational plans. The second would be operational plans in the provinces led by their premiers.

Deputy President Kgalema Motlanthe, who chairs Sanac, is understood to have written to premiers urging them to have operational plans in place by December 1 this year.

The third step involves drawing other government departments into the HIV/Aids fight. “The health department has played a crucial role in the national strategic plan and Sanac, but other crucial departments did not do the same,” Heywood said.

An audit of the 19 civil society sectors in Sanac is under way to determine whether they can implement a plan framework. Some rationalisation and amalgamation are expected in this sector.

Three strategic campaigns are likely to emerge, underpinned by a vision of zero new infections, zero deaths and zero stigma. The first will focus on testing and knowing one’s status and the second will try to mobilise South Africans on health issues, with access to treatment the main aim. The third will seek to achieve safety and dignity for all people living with HIV/Aids by stopping violence against them and discrimination in the workplace.

Yogan Pillay, deputy director general in the health department, cautioned against setting too many objectives. He said the two main targets in the present plan had been an advantage and added: “It’s important that we figure out how to hold role players accountable. The health department has been crucified at every meeting, so we are keen for the new plan to be far more inter-sectoral.”

He said more attention should be paid to what happened at district level or “we will have a good plan and no implementation”. Heywood said he was the first to admit that “we absolutely have to reform Sanac”, which was dysfunctional and did not work efficiently. “We need an accountable, leaner and more efficient body to oversee the implementation of the next plan.”

Heywood said Sanac had been created “in a different age of the response” — an allusion to Tshabalala-Msimang’s term as health minister. — Health-e News Service